An interactive computer system evaluates and diagnoses based on cytologic features derived directly from a digital scan of fineneedle aspirates (FNA) slides. A consecutive series of 569 patients provided the data to develop the system and an additional 54 consecutive, new patients provided samples to test the system. The projected prospective accuracy of the system estimated by tenfold cross validation was 97%. The actual accuracy on 54 new samples (36 benign, 1 atypia, and 17 malignant) was 100%. Digital image analysis coupled with machine learning techniques will improve diagnostic accuracy of breast fine needle aspirates.